OB Adaptive quizzing test 3 CH 33

Which medication is contraindicated in a client who is on anticoagulant therapy? Aspirin (Ecotrin) Clindamycin (Cleocin) Misoprostol (Cytotec) Ergonovine (Ergotrate)

Aspirin (Ecotrin)

The nurse is assessing a postpartum client 4 hours after delivery. The nurse observes that the client has cool, pale, and clammy skin with severe restlessness and thirst. What should the immediate nursing intervention be? Begin fundal massage and start oxygen therapy. Begin an hourly pad count and reassure the client. Elevate the head of the bed and assess vital signs. Assess for hypovolemia and notify the primary health care provider.

Assess for hypovolemia and notify the primary health care provider.

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to what? Acidify the urine by drinking three glasses of orange juice each day. Maintain a fluid intake of 1 to 2 L/day. Empty her bladder every 4 hours throughout the day. Perform perineal care on a regular basis.

Perform perineal care on a regular basis.

Which term is used to describe perforation of the uterus due to placental adherence to the uterine walls? Placenta previa Placenta increta Placenta accreta Placenta percreta

Placenta percreta

While performing a physical examination of a postpartum client, the nurse finds that the uterus is firm and contracted. The client reports dark red lochial discharge. Which treatment strategy may help prevent further complications in the client? Tocolytics Stool softeners Anticoagulants Halogenated anesthetics

Stool softeners

A client who has postpartum bleeding due to uterine subinvolution has not recovered from drug therapy. Which procedure would be helpful in managing the bleeding in this client? Massaging the abdomen Using a nonrebreather mask Indwelling a urinary catheter Inserting a fist into the vagina

The client is continuously bleeding despite conventional therapy. In this situation, the client is subjected to bimanual compression. In this procedure the fist is inserted into the vagina and knuckles are pressed against the anterior side of the uterus. This maneuver positions the uterus in the pelvic cavity. Uterine massage is also helpful in managing postpartum hemorrhage (PPH). However, uterine massage is not done by massaging the abdomen, but by placing one hand on the abdomen and massaging the posterior side of the uterus. A urinary catheter is indwelled to determine the urinary output. A nonrebreather face mask is given to the client when the client has hypoxemia.

What is the first and most important nursing intervention when a nurse observes profuse postpartum bleeding? Call the woman's primary health care provider Administer the standing order for an oxytocic Palpate the uterus and massage it if it is boggy Assess maternal blood pressure and pulse for signs of hypovolemic shock

The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus the primary health care provider should be notified or the nurse can delegate this task to another staff member. Administering the standard order for an oxytocic is appropriate after assessment and immediate steps have been taken to control the bleeding. Vital signs will need to be ascertained after fundal massage has been applied.

A postpartum client who had undergone a cesarean reports to the nurse about fever, loss of appetite, pelvic pain, and foul-smelling lochia. Upon assessment, the nurse finds that the client has an increased pulse rate and uterine tenderness. The laboratory reports indicate significant leukocytosis. What clinical condition should the nurse suspect based on these findings? Cystocele. Rectocele. Hematoma. Endometritis.

Endometritis.

Which PPH conditions are considered medical emergencies that require immediate treatment? Inversion of the uterus and hypovolemic shock Hypotonic uterus and coagulopathies Subinvolution of the uterus and idiopathic thrombocytopenic purpura Uterine atony

Inversion of the uterus and hypovolemic shock

The nurse finds that despite gentle traction to the umbilical cord and uterine massage, the client's placenta has not expelled out even after 30 minutes of childbirth. The primary health care provider instructs the nurse to administer nitroglycerin IV (Nitrostat) to the client. What could be the reason for this instruction? Prevention pelvic hematoma To increase the effects of regional anesthesia To promote uterine relaxation Prevention of postpartum hemorrhage

To promote uterine relaxation

Which ratio would be used to restore effective circulating volume in a postpartum client who is experiencing hypovolemic shock? 4:1 2:1 1:1 3:1

A 3:1 ratio of 3 ml infused for every 1 ml of estimated blood lost is recommended to restore circulating volume.

While assessing a postpartum client the nurse finds that the client has excessive foul smelling lochia. What medication would be helpful in treating the condition? A broad-spectrum antibiotic A diuretic to induce urination Intravenous oxytocin agents Intravenous fluids A diuretic to induce urination Intravenous oxytocin agents Intravenous fluids

A broad-spectrum antibiotic

A client diagnosed with endometritis is prescribed clindamycin (Cleocin). What comfort measures does the nurse teach the client? Avoid sitz baths. Use warm blankets. Decrease fluid intake. Change perineal pads. Avoid cool compresses.

A client diagnosed with endometritis is instructed to use warm blankets to cover the body for pain relief. The client should also be instructed to change the perineal pads, so as to prevent the spread of infection. The client is advised to change the perineal pads from front to back to maintain hygiene at the infected site. Sitz baths are encouraged to maintain hygiene and provide comfort. Fluid intake is suggested to maintain the fluidity of the blood. Applying cool compresses to the site of infection is advised to relieve discomfort caused by the infection.

A 28-year-old multipara delivered a 9 pound, 3 ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take? Massage the fundus Check her perineum. Assess her vital signs. Check the tone of her fundus.

Check her perineum. The client is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage. Risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth. Because vital signs change late, the fastest way to see the amount of current hemorrhage is to check the perineum. The fundus would be massaged and additional nursing and medical interventions would be instituted.

Upon assessment the nurse finds that the client who has undergone a cesarean delivery is at risk of postpartum hemorrhage (PPH). What would be the most likely cause of PPH in this client? Anesthesia Coagulopathy Placenta previa Chorioamnionitis

Anesthesia blocks the neurologic impulses that stimulate uterine contractions (UCs). This causes uterine atony and can lead to PPH. Chorioamnionitis is a serious condition in which the fetal membranes are infected, and is associated with other signs, such as fever. Coagulopathy is a clotting disorder, which occurs due to protein defects in the plasma that interrupt the coagulation cascade and cause blood coagulation. Placenta previa is an obstetric complication in which the placenta penetrates partially in the lower uterine segment. This is a common complication in pregnant women who smoke and consume cocaine.

A postpartum client with hemorrhagic shock is administered intravascular colloids. The nurse monitors the client carefully throughout the colloid administration. What risk factor in the client should the nurse be aware of? Excessive hemorrhage Von Willebrand disease Deep venous thrombosis Intravascular fluid overload

Clients who are given intravascular colloids are at a higher risk for intravascular fluid overload. Therefore, the nurse should monitor the client for symptoms of intravascular fluid overload. Intravascular colloid therapy does not cause excessive hemorrhage. Von Willebrand disease, a hereditary disease condition, is a type of hemophilia. Von Willebrand disease is caused by the deficiency of a blood clotting protein called Von Willebrand factor (vWF). Deep venous thrombosis is a venous thromboembolic disorder that is most commonly seen in the lower extremities. It is unrelated to intravascular colloid therapy.

The postpartum client who delivered a day ago reports, "I feel tired very often and experience pain in my lower abdomen." Upon further observation, the nurse finds that the client also has profuse foul-smelling vaginal discharge and an increased pulse. Which medication would be added to the client's prescription? Warfarin (Coumadin) Clindamycin (Cleocin) Misoprostol (Cytotec) Ergonovine (Ergotrate)

Endometrial infection is characterized by tiredness and lower abdominal pain, profuse foul-smelling discharge, and increased pulse. Clindamycin (Cleocin) is an antibiotic used to treat endometrial infections. Warfarin (Coumadin) is prescribed to postpartum clients with thromboembolic disorders. Misoprostol (Cytotec) is prescribed to clients with excessive bleeding caused by uterine atony. Ergonovine (Ergotrate) is prescribed to treat subinvolution of the uterus.

The nurse is caring for a client who is undergoing treatment for deep vein thrombosis (DVT). Which signs and symptoms will the nurse monitor in the client to evaluate the patient's response to treatment? Dysuria, petechiae, and vertigo Petechiae, hematuria, and dysuria Hematuria, increased lochia, and vertigo Hematuria, petechiae, and increased lochia

Hematuria, petechiae, and increased lochia

In which situations would the use of methergine or prostaglandin be contraindicated even if the client were experiencing a postpartum significant bleed? Delivered twin pregnancies. Client's blood pressure postpartum is 180/90 Client has a history of asthma Client has a mitral valve prolapse Client is a grand multipara

If a client is hypertensive, then these medications would not be used. If a client has a history of asthma, then prostaglandin would not be used. If the client had cardiovascular disease, then these medications would not be used. Twin pregnancies successfully delivered would not be a contraindication to the use of these medications. The fact that a client is a grand multipara would not be a contraindication to the use of these medications.

A postpartum client who underwent a cesarean delivery complains of minor perineal and rectal pain. Further assessment shows the presence of peritoneal hematomas. Which primary nursing interventions should be performed after surgically removing the hematomas and minimizing the bleeding? Prepare for hysterectomy. Administer pain relief medication. Initiate fluid replacement therapy. Monitor serum hemoglobin levels. Monitor the amount of blood loss.

Initiate fluid replacement therapy. Monitor serum hemoglobin levels. Monitor the amount of blood loss.

What measures will the nurse implement in her postpartum client to prevent postpartum infection and other possible complications? Instruct the client to consume foods that are rich in iron. Instruct the client to wash hands with soap after urination. Perform fundal massage on the client when necessary. Instruct the client to change the perineal pads from front to back. Inform the client to avoid consuming an excess amount of water.

Instruct the client to consume foods that are rich in iron. Instruct the client to wash hands with soap after urination. Perform fundal massage on the client when necessary. Instruct the client to change the perineal pads from front to back.

After massaging the boggy fundus of a client who delivered a large baby after a prolonged labor with a forceps-assisted birth, the nurse is unable to obtain a firm fundus. What nursing action is indicated at this time? Increase the rate of the intravenous infusion. Massage the fundus while another nurse notifies the PCP. Change the peripad, replacing it with a double pad. Administer a half-dose of a uterine contracting medication.

Massage the fundus while another nurse notifies the PCP.

After reviewing the medical reports of a client, the nurse finds that the client has multifetal gestation. What could be the most likely complication associated with this? Vaginal hematomas Von Willebrand disease (vWD) Postpartum hemorrhage (PPH) Abnormal development of limbs

Postpartum hemorrhage (PPH)

It has been determined after ultrasound that a small piece of the placenta remains in the uterus over an hour after birth, causing the fundus not to be firm and excessive bleeding to continue. Because the client delivered a large infant with a small dose of intravenous pain medication, what action should the nurse take? Preparing the client for the removal of the retained placental fragment, including the use of anesthesia. Encouraging the consumption of oral fluids to expand the fluid volume. Preventing the mother from nursing her infant until her vital signs are stable. Encouraging the mother to nurse as much as possible to clamp down the fundal vessels.

Preparing the client for the removal of the retained placental fragment, including the use of anesthesia.

Which condition in the client may lead to uterine atony? Primigravidity Prolonged labor Polyhydramnios Precipitous birth Fetal macrosomia

Prolonged labor causes the uterus to expand for a longer period of time, which may result in uterine atony. Polyhydramnios causes the uterus to overstretch, leading to uterine atony. Excessive stretching of the uterine muscles may occur due to the presence of a large fetus. It is called fetal macrosomia. Primigravidity does not cause uterine atony, because it does not affect the uterine muscles. Precipitous birth, or rapid birth, does not cause uterine atony, but may lead to vaginal and cervical lacerations.

What are the signs and symptoms associated with urinary tract infections (UTIs)? Dysuria Oligouria Erythema Hematuria Low grade fever

UTIs are associated with dysuria, low grade fever, and hematuria. Dysuria is caused by the growth of bacteria in the urinary tract. Bacterial infection of the urinary tract also causes low grade fever. Hematuria is caused by ruptured uterine layers due to a bacterial infection. Urinary tract infection may manifest as increased frequency and urgency of micturition. It is not associated with oligouria, which refers to the decreased production of urine. Erythema is the redness of the skin, which is a sign of wound infection after childbirth.

The ultrasonography report of a pregnant woman reveals the presence of polyhydramnios. What complication would the nurse expect during the postpartum period? Hematomas Uterine atony Retained placenta Endometrial infections

Uterine atony

A postpartum client shows clinical manifestations of hemorrhage and pain. Upon vaginal examination, the nurse finds a smooth mass through the dilated cervix. Which intervention should be performed to prevent blood loss and pain? Administer an oxytocic agent to the client. Administer light nitrous oxide to the client. Administer halogenated anesthetics to the client. Administer intravenous nitroglycerin to the client. Administer broad-spectrum antibiotics to the client.

Administer an oxytocic agent to the client. Administer intravenous nitroglycerin to the client.

Thromboembolic conditions that are of concern during the postpartum period include: Amniotic fluid embolism (AFE) Superficial venous thrombosis Deep vein thrombosis Pulmonary embolism Disseminate intravascular coagulation (DIC)

An AFE can occur during the intrapartum period when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs. DIC is an imbalance between the body's clotting and fibrinolytic systems. It's a pathologic form of clotting that consumes large amounts of clotting factors.

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect what? Bladder distention Uterine atony Constipation Hematoma formation

Bladder distention would result in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony would result in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

After removal of the retained placental fragment, the client is recovering on the mother-baby (postpartum) unit. What should the nurse identify as the priority of care? Monitoring the infant's ability to breastfeed. Checking the perineum frequently. Assessing vital signs frequently. Encouraging the client to ambulate.

Checking the perineum frequently.

Which indicator would lead the nurse to suspect that the postpartum client experiencing hemorrhagic shock is getting worse? Restoration of blood pressure levels to normal range Capillary refill brisk Client complains of headache and reaction time increases to asking questions Client states she sees "stars"

Client complains of headache and reaction time increases to asking questions

What is the primary cause of thromboembolic disease? Viral infection Hypercoagulation Corticosteroid therapy Deficient clotting factors

Hypercoagulation

postpartum client is bleeding continuously and excessively due to uterine atony. Which medications administered to the client may cause postpartum hemorrhage? Oxytocin (Picotin) Halothane (Fluothane) Nitrous oxide (Anesoxyn) Nitroglycerine (Nitrostat) Magnesium sulfate (Generic)

Oxytocin (Picotin) Halothane (Fluothane) Magnesium sulfate (Generic)

While assessing a postpartum woman, the nurse finds dark red blood coming from the vagina. What can the nurse infer about the client's condition by observing the blood's color? The client has partial placental separation. The client has a deep laceration of the cervix. The client has superficial lacerations of the birth canal. The client has disseminated intravascular coagulation (DIC).

Superficial lacerations of the birth canal are characterized by dark red blood oozing from the vagina. The dark red color indicates its venous origin. Partial placental separation is characterized by spurts of blood with clots. Deep laceration of the cervix is characterized by bright redarterial blood. DIC is a condition in which the blood fails to clot or remain clotted. If the client had DIC, the color of the vaginal blood would be bright red.

A postpartum client with hemorrhagic shock has been administered intravenous (IV) infusion of crystalloid solution. Upon reviewing the client's laboratory reports, the nurse finds that platelet count and clotting factor levels are not improved. What is the best treatment option in this situation? Infusion of fresh frozen plasma Provide supplemental oxygenation Administer packed red blood cells Increase the dose of crystalloid solution

When a postpartum client has excessive bleeding due to hemorrhagic shock, an IV infusion of crystalloid solution is administered. If the platelet count is not restored even after the crystalloid IV infusion process, then fresh frozen plasma has to be infused. Fresh frozen plasma contains all the coagulation factors and it helps to restore platelet counts. Packed RBCs are administered if the client has active bleeding, despite the initial crystalloid administration. Increasing the dose or volume of crystalloid solution will not increase the levels of clotting factors and platelets. Supplementary oxygenation is given to compensate for the reduced tissue perfusion when the client has hypovolemic shock. Supplementary oxygenation does not increase the levels of clotting factors and platelets.

A primary health care provider prescribed 15-methylprostaglandin F2α (Carboprost) to a client. What history does the nurse check before administering this drug to the patient to prevent complications? Asthma Diabetes Joint pain Migraine pain

Methylprostaglandin F2α (Carboprost) causes uterine contractions (UCs) and is used to prevent postpartum hemorrhage (PPH). The medication also causes bronchoconstriction. If it is administered to an asthmatic client, it may aggravate bronchoconstriction and cause status asthmaticus. Therefore it is contraindicated in the asthmatic client. Thus, the nurse should check for the history of asthma in the client before administering 15-methylprostaglandin F2α (Carboprost). The medication 15-methylprostaglandin F2α (Carboprost) does not interfere with blood sugar levels, joint structure, or cerebral blood flow. Therefore it can be safely administered to clients with diabetes, joint pain, and migraine pain.

A client who is 32 weeks pregnant visits a maternal clinic for a routine health checkup. The ultrasound and magnetic resonance imagining (MRI) reveal that the woman is at risk of placenta accreta. Which intervention should be performed during the delivery to ensure client's safety? Blood transfusion Hysterectomy after delivery Natural removal of the placenta Administration of uterine contractile drugs

Natural removal of the placenta

A postpartum woman with asthma who had manual repositioning of her uterus into the pelvic cavity after uterine inversion, experiences prolonged lochial discharge and hemorrhage. Upon examination, the nurse finds a large, boggy uterus. Which nursing intervention may pose the most risk to the client? Removal of retained placental fragments Administration of carboprost (Hemabate) Aggressive massage of the uterine fundus Administration of intravenous oxytocin (Pitocin)

Aggressive fundal massage should be avoided in a client who underwent a manual repositioning of the uterus, because this may increase the risk of bleeding. Subinvolution of the uterus is the delayed return of the uterus to its normal size and function. Subinvolution of the uterus is characterized by prolonged lochial discharge, excessive bleeding, hemorrhage, and a large, boggy uterus. Retained placental fragments should be removed by performing dilation and curettage. This may reduce excessive bleeding. Carboprost (Hemabate), a uterotonic medication, is used if the uterus is nonresponsive to the continuous oxytocin (Pitocin) infusion. Carboprost (Hemabate) is contraindicated in clients with asthma. Because the client has asthma, carboprost (Hemabate) should not be administered to the client. Administration of intravenous oxytocin (Pitocin) along with normal saline promotes restoration of normal uterine tone and size.

The nurse is caring for a postpartum client who is diagnosed with superficial venous thrombosis. Which interventions will the nurse perform for a client with this condition? Change the client's position frequently. Apply moist heat to relieve the client's pain. Inspect the affected site by gently palpating it. Massage the affected area suitably for comfort. Allow the client to rest with legs in a low position.

Change the client's position frequently. Apply moist heat to relieve the client's pain. Inspect the affected site by gently palpating it.

What is the treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage? Cryoprecipitate Factor VIII and vWf Desmopressin Hemabate

Desmopressin Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products such as factor VIII and vWf is an acceptable option for this client. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

A nurse is making rounds on a client who recently delivered via the vaginal route, and suspects that the client is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time? Call the physician Massage the uterine fundus Increase the rate of intravenous fluids Monitor pad count and perform catherization

Massaging of the uterine fundus would be a priority action to help expel clots and stimulate uterine contractions to constrict blood flow. Although the physician may well have to be called, the initial priority action would be for the nurse to massage the uterine fundus. Although the rate of intravenous fluids may have to be increased, this is not the priority action at this time. Monitoring of pad count and lochia flow is needed but it is not the priority action at this time. Additionally, catherization may be needed if bladder distension is noted but, again, it is not the priority action at this time.

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? Endometritis Wound infections Mastitis Urinary tract infections (UTIs)

Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding. Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision, and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal exams, and epidural anesthesia.

Upon assessing a client who is in the third stage of labor, the nurse notices that the client is experiencing vaginal bleeding with spurts of blood and clots. What does the nurse believe is the cause of the bleeding? Deep cervical laceration Intravascular coagulation Superficial vaginal laceration Partial placental separation

Partial placental separation

After reviewing the medical reports of a client, the nurse finds that the client has submucosal uterine fibroids. Which postpartum complication of pregnancy is the client likely to have? Placenta accreta Impaired lactation Vaginal hematomas Postpartum hemorrhage

Placenta accreta is a slight penetration of the placenta into the myometrium of the uterus. The clientwho has submucosal fibroids has a higher risk of developing placenta accreta. The symptom of placenta accreta can be diagnosed before birth using an ultrasound and magnetic resonance imaging (MRI). Submucosal fibroids do not have any effect on lactation. Therefore, they do not pose a risk of impaired lactation in the client. Vaginal hematomas are associated with forceps-assisted birth, episiotomy, or primigravidity. Submucosal uterine fibroids do not have any effect on the integrity of the vaginal walls. Therefore, submucosal uterine fibroids do not cause vaginal hematomas. The client's reports suggests that the placenta is adherent to the uterine wall. This does not indicate that the client is at risk of postpartum hemorrhage.

A client diagnosed with placenta accreta has uncontrolled bleeding, despite administering medications. What should be the best choice for treatment in this situation? Massage the uterus Prepare the client for surgery Replace blood components as needed Apply traction on the umbilical cord

Prepare the client for surgery Placenta accreta is an obstetric complication in which the placenta adheres to and penetrates the myometrium. The patient with placenta accreta is at risk of having hemorrhage during childbirth. If bleeding is not stopped after the administration of medication to the client, then a hysterectomy has to be performed to prevent further complications. Replacement of blood components is not useful, because the client has uncontrolled bleeding. Massaging the uterus and applying traction to the umbilical cord is helpful to expel the placenta, but is not useful when the placenta is adhered to the uterus.

A client who has undergone cesarean surgery reports to the nurse about having persistent perineal pain and feels pressure in the vagina. The nurse finds that the client is in shock. What clinical condition should the nurse suspect based on this assessment? Rectocele. Endometritis. Impaired lactation. Retroperitoneal hematoma.

Retroperitoneal hematoma. Accumulation of blood in the retroperitoneal space is called retroperitoneal hematoma. It is caused by the rupture of the cesarean scar during labor. Retroperitoneal hematoma is characterized by such symptoms as persistent perineal pain, a feeling of pressure in the vagina, and shock. Therefore it is evident that the client has this condition. Persistent perineal pain, a feeling of pressure in the vagina, and shock are not associated with rectocele, endometritis, and impaired lactation. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is characterized by fever, increased pulse rate, chills, anorexia, nausea, fatigue, pelvic pain, uterine tenderness, and foul-smelling lochia. Because the client did not report these symptoms, the client does not have endometritis. Perineal pain, a feeling of pressure in the vagina, and shock do not affect lactation, so the client does not have impaired lactation.